There is not always truth in advertising, but when you really lie, you really pay - especially if you happen to be an enormous drug company.

In the largest settlement ever for wrongful drug marketing, Pfizer agreed to pay a total of $2.3 billion in fines for promoting medicines for unapproved uses and will plead guilty to illegally marketing the painkiller Bextra, The Wall Street Journal reported. The settlement resolves charges raised by the Justice and Health and Human Services departments. (Bextra was pulled from the market in 2005.)

Pfizer apparently encouraged doctors to prescribe four medicines to treat symptoms the drugs were not FDA approved to treat. The settlement also resolves allegations that Pfizer induced doctors to promote these "off-label" uses by paying for their meals and subsidizing their travel.

One hopes that the biggest fine ever will encourage Pfizer to clean up its act in a way previous settlements apparently failed to do.

WSJ: The settlement is the third in which Pfizer signed a "corporate integrity" agreement pledging to clean up its drug-marketing practices. It signed the agreements in 2002 over Lipitor and in 2004 over epilepsy drug Neurontin. Under the latest agreement, Pfizer will have to create a mechanism for doctors to report questionable conduct by Pfizer sales representatives.

Questions of corporate integrity in the drug company world are also being raised in a Manhattan civil court trial against Merck - the first case to reach trial of a reported 1,200 pending against the drug company relating to Fosomax, a bone-loss prevention drug for women.

The New York Times notes that analysts, lawyers and drug companies are all watching the litigation to assess Merck's financial liability, especially considering its pending $41 billion merger with Schering-Plough.

The case involves whether or not Fosomax caused a rare condition that results in the breakdown of the jaw bone - and of course evidence has included internal emails and company documents the plaintiff alleges show Merck was aware of the potential side effect and failed to take action. Merck counters that it took immediate action once it became aware of the potential of jaw-harming side effects.